Trends and Outcomes of Same-Day Discharge After Pediatric Laparoscopic Pyloromyotomy.

INTRODUCTION

Enhanced recovery after surgery protocols following pediatric pyloromyotomy have been published; however, literature evaluating same-day discharge (SDD) is lacking. This analysis aimed to evaluate SDD outcomes following laparoscopic pyloromyotomy.

MATERIALS AND

METHODS

The American College of Surgeons National Surgical Quality Improvement Program Pediatrics database (2017-2021) was queried for patients with pyloric stenosis who underwent laparoscopic pyloromyotomy. Preterm infants, patients aged <4 wk or >6 mo, and open operations were excluded. Patients discharged same day postoperatively (SDD) were compared to those discharged 1-2 d postoperatively (non-SDD). Regression analysis was performed.

RESULTS

Of 5851 patients, 367 (6.3%) were SDD. There were significant differences between SDD and non-SDD in weight (4.29 kg versus 4.20 kg; P = 0.035), and operative time (23.30 min versus 29.43 min, P < 0.001). Overall, 34 patients (0.6%) required readmission within 2 d of discharge, with a higher rate in the SDD cohort for emesis (1.1% versus 0.2%; P = 0.012), but no difference in 2-d readmission overall (1.4% versus 0.5%, P = 0.059). There were no significant differences between cohorts for other outcomes. Regression demonstrated American Society of Anesthesiologists (ASA) classes (2-4) increased odds of 30-d readmission (ASA 4: odds ratio 8.89, 95% confidence interval 2.38-33.26, P = 0.001).

CONCLUSIONS

Most laparoscopic pyloromyotomy patients are not eligible for SDD; however, it can be reasonable in select patients tolerating feeds with lower ASA classes. SDD results in a 1% increase in early readmission for emesis without an increase in overall readmissions or other complications, which occur at low single-digit percentages.